The prognostic value of cerebrospinal fluid procalcitonin in acute bacterial meningitis in children

Abstract number: 1134_04_5

Iubu R., Jianu C., Tatulescu D., Marcu C., Ursu L.

Background:  

It was shown that serum procalcitonin (PCT) was a better marker than serum C – reactive protein and cerebrospinal fluid (CSF) parameters in differentiating between acute bacterial meningitis (ABM) and viral meningitis in children. The production of PCT during inflammation is linked with a bacterial endotoxin and with inflammatory cytokines (TNF, IL-6). In children PCT is generally not detectable in CSF.

Objectives:  

The aim of our prospective study was to evaluate if a detectable level of PCT in CSF might be correlated with severity of disease and can therefore be used as a prognostic marker in ABM in children.

Methods:  

PCT levels was measured in serum and CFS of 33 children patients diagnosed with ABM admitted in our department. Meningitis was considered to be bacterial by a positive result on gram staining and/or bacterial culture of CFS or a positive blood culture in combination with clinical evidence of meningitis and CFS parameters (PMN counts, protein levels, ratio of glucose in CFS to glucose in serum, lactat CFS levels). PCT was estimated by an immunochromatographic assay (Brahms PCT – Q).

Results:  

The median age of the patients was 4.1 years (range, 3 months to 8 years). The microbiologically results yielded Neisseria meningitidis in 18 patients, Streptococcus pneumoniae in 9, Haemophilus influenzae type b in 4 and Escherichia coli in 2. A high serum PCT concentration (>10 ng/ml) identified in all 33 studied patients, except in two patients with previous antibiotic therapy; these had a lower serum levels of PCT (>5 ng/ml), that demonstrated the PCT decrease during treatment for ABM. In 16 children we found a detectable level of CFS procalcitonin: >10 ng/ml in 4, >2 ng/ml in 7 and >0.5 ng/ml in 5 patients. Levels of CFS procalcitonin >2 ng/ml (11 patients) were correlated with severity of disease (two children died, 5 recovered with serious neurological sequelae and 4 developed complications and required more than 21 days of treatment) and with young age (the median age was 2.2).

Conclusions:  

A CFS procalcitonin concentration >2 ng/ml, in MAB, was highly associated with a poor prognosis. We considered that measured of PCT in CFS will enable accurate prediction of mortality risk in children with ABM, particularly younger than 3 years age and can be included in a prognostic scoring system.